Magazine article Drug Topics

Physicians Decry Push by Managed Care to Limit Drugs

Magazine article Drug Topics

Physicians Decry Push by Managed Care to Limit Drugs

Article excerpt

Consolidation in the drug industry "may provide an unfair competitive advantage to pharmaceutical manufacturers that own pharmaceutical benefit management companies," the American Medical Association said in a report adopted unanimously by its house of delegates at its annual meeting in Chicago. "FTC [Federal Trade Commission] requirements may provide a sufficient safeguard against abuse. If not, then it may be necessary to prohibit manufacturers from purchasing PBMs entirely," the report warned.

AMA urged physicians who see any "inappropriate influence" on formulary development from industry consolidation to notify authorities such as the FTC and the Food & Drug Administration.

An AMA council also warned of the ethical pressures being put on physicians and the risks to patients from overly restrictive formularies and other techniques such as pressures to change prescriptions.

Drug companies presumably want their PBMs to give preference to their products in promotion and marketing, the report said. Both the FTC and the FDA have responded to these apparent conflicts by undertaking a review of the PBM purchases for antitrust violations and warning the manufacturers not to pressure physicians to prescribe drugs that are not medically necessary or withhold warnings to patients about adverse side effects.

In one such deal--Eli Lilly's purchase of PCS Health Systems--the FTC required the company to keep its formulary open to other companies' products and to build a "fire wall" so that it did not obtain other companies' pricing information. But it is unclear how the FTC intends to monitor and ensure compliance with those requirements, the report said.

The question of whether formularies save money is open to debate, the report continued. Empirical data vary, the report noted, but one unpublished study at Duke University found that limiting a physician's choice of drugs for ulcers, asthma, and heart conditions saved a "marginal" amount of money but resulted in greater hospitalization, offsetting any savings. …

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